Learning Disability NOT FINISHED

Question 1

Which terms are used in the UK?

Answer 1

Learning disability = official UK term. Designates specific learning disasbility in many countries
Learning difficulty = used by educational services in UK. Probably preferred by people with LD

Question 2

What is the WHO definition of ‘mental retardation’ (not a term used in the UK)?

Answer 2

Mental retardation is a condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence, i.e. congnitive, language, motor and social abilities

Question 3

What is the 4 key points under the definition of learning disability?

Answer 3

1. General impairment of intellectual functoining
2. Consequences in terms of severe impairment of social functioning
3. Onset before physical maturity
4. Therefore excludes people who develop cognitive impairments in adult life, and people with specific impairments such as dyslexia

Question 4

What 2 tests can be used to assess learning disability?

Answer 4

IQ test

Adaptive behaviour scales e.g. Vineland, ABS etc

Question 5

What is an IQ test?

Answer 5

IQ test
developed to identify children who needed special educational help. Includes questions measuring a range of intellectual skills and knowledge, summed and weighted as a composite score. Scores standardised, with 100 as population mean

Question 6

What is an adaptive behaviour test?

Answer 6

Measure skills in daily living by checklists, interviews with carers and observations in activities such as self-help, basic academic skills, communication, mobility, everyday coping skills and social competence.
Generates a series of rating scales rather than an overall score

Question 7

What are the problems with IQ tests?

Answer 7

• Measure a narrow range of skills. Results do not always reflect how someone copes in everyday life
• Under-performance. Subject may not understand why test is used, may have additional disabilities which affect score.
• Invalid application. IQ tests not designed for or standardised on people with LD, who may have very uneven balance of strengths and weaknesses

Question 8

What are the problems with AB scales?

Answer 8

• Ignore extent of support from a carer, or whether communication aids available
• May be variability in performance between settings (transferability problem)
• Include assumptions about activities appropriate to a particular culture
• Poor performance may indicate lack of opportunity rather than lack of skills
• Core skills change over time, e.g. cooking less important but skill in use of a compute being redefined as a core competence

Question 9

What can these measurements be used to do?

Answer 9

• identify areas in which people most need help to learn and to achieve. Use multiple measures to get a profile of strengths and weaknesses
• measure changes in performance over time and as result of therapeutic action
• identify eligibility for specific services for disabled people or where there is a risk of mistreatment (e.g. in criminal proceedings)

Question 10

How is learning disability catergorised in terms of IQ?

Answer 10

Mild = 50-70
- Holds conversations. Full independence in self-care. Basic literacy.
Moderate = 35-50
- Limited language. Needs supervision in self-care. Usually fully mobile.
Severe = 20-35
- Uses words/gestures for basic needs. Activities need to be supervised. Marked motor impairment likely.
Profound = <20
- Very limited words, gestures or none. Severely limited mobility. Incontinent.

Question 11

Notes to mention about categorising LD with IQ

Answer 11

• grades are not discrete groups, and assessment should take account of sensory impairment
• four-grade system often modified e.g. into mild and severe. Term ‘profound and multiple learning disability’ used in UK. Also ‘borderline LD’ for people with significant social impairments

Question 12

Describe the epidemiology of mild learning disability.

Answer 12

• 18/1000 across all age-ranges
• most do not have identified organic cause
• strongly associated with poverty and disadvantage
• most not in contact with specialist services, and rates on registers therefore increase through school years, and then decrease after leaving school

Question 13

Describe the epidemiology of severe learning disability.

Answer 13

• 3-4/1000 people have moderate, severe or profound LD
• much more likely to have an identified organic cause
• less association with poverty than mild LD
• contact with specialist services continues after school, but high mortality rates result in declining proportion among the elderly

Question 14

There has been a steady increase in the prevalence of learning disabilities. Give some possible reasons for this

Answer 14

Possible increase because of:

• limited impact of preventive measures
• increasing number of premature babies surviving, often with LD
• increased number of children with severe LD surviving into adulthood
• greater life-expectancy of adults with LD

Question 15

What is the difference between expressive and receptive communication?

Answer 15

Receptive = understanding
Expressive = speaking

Question 16

What is the significance of communication in LD?

Answer 16

• communication problems associated with challenging behaviour
• in terms of healthcare services, think of people with LD as a communication minority, comparable to people who are deep, blind, illiterate or who do not speak the host language

Question 17

What tools can be use to assist communication?

Answer 17

Environmental adaption - signs, colourcoding etc
Interpretors - translators, sign language, Makaton
Assisted communication - braille, symbol systems, message board, but also use of simpler english

Question 18

What is normalisation 1 and 2?

Answer 18

Normalisation 1

• Scandinavian approach emphasises the importance for the disabled persons to attain adulthood by overcoming the ordinary challenges of life
• compensatory services are needed to enable the disabled person to overcome these challenges, and also to live a life comparable to that of other people in society

Normalisation 2 (social role valorisation)

• US approach notes the ease by which disabled people are assigned derogatory labels because of the separateness of their appearance, environment or way of life
• Therefore wary of specialist services which identify disabled people as different. Proposes importance of them being associated with valued social roles. Now renamed ‘social role valorisation)

Question 19

What is the impact of universalism?

Answer 19

• closure of large institutions. preference for ordinary domestic settings, domiciliary care. Suspicion of separate disabled services/schools
• greater access for disabled people to universal public services, employment, and community facilities. This enforced by law and political action.

Question 20

What is the challenge to universalism?

Answer 20

• rise of consumerism, with people defining self as what they purchase from competing corporations
• diminished sense of collective reponsibility arising from less engagement with others, and perception of others as threat
• may lead to loss of sense of people sharing universal rights - disabled seen as ‘negative consumers’

Question 21

What are the 4 prevention strategies for LD?

Answer 21

Preconceptional - prenatal (DS) or newborn (PKU) screening
Prenatal - folate therapy in pregnancy, health education to reduce alcohol consumption in pregnancy
Perinatal - optimal obstetric, neonatal care
Postnatal - health education to reduce accidents, vaccinations

Question 22

What things should you do in a consulatation with a disabled person?

Answer 22

1. first appointment
2. double appointment
3. outline content of consultation and what is going to happen
4. ask patient first then check with carer and compare
5. use simple language and communication aids
6. do not assume understanding of cause of diseases
7. check understanding by asking open questions and then asking then to repeat back
8. concept of time often hard to understand e.g. don’t say take twice a day, but say take with breakfast and dinner
   9.